Abstract 311: Cost-effectiveness Analysis of California Hospitals That Perform Coronary Artery Bypass Graft Surgery

Objectives: California collects clinical data on coronary artery bypass graft (CABG) surgeries and has published a hospital level risk-adjusted performance report for every data year since 2003. Recent efforts have for the first-time combined hospital level utilization and financial data to components of the clinical CABG data. With the goal of understanding how performance might vary by hospital financial aspects, a cost-effectiveness analysis (CEA) of the 125 California hospitals that performed CABG surgery in 2016 was completed.

Methods: Patient-level clinical data for the 125 California licensed hospitals that performed CABG surgery in 2016 were linked to patient discharge data and California death records. Selected patient-level characteristics from this data were then merged with hospital-level financial and utilization data. The 34 hospitals that report financial data at a network or corporate level were excluded, resulting in a cohort of 91 hospitals. A CEA was conducted to understand cost summaries and variations across hospitals that perform CABG surgery in California. Resources and information essential for cardiac surgery programs such as hospital personnel time, source charges and payments, patient complications and in-hospital mortality rates were evaluated.

Results: Gross inpatient revenue in 2016 for the 91 CABG hospitals for total surgery and recovery services (which includes open heart surgeries) was $21.5 billion for an average of $236.5 million per hospital. Revenues ranged from $28.8 million to $1.3 billion. Total direct expenses for total surgery and recovery services (which includes open heart surgeries) were $1.8 billion and ranged from $2.6 million to $105.4 million with an average of $20.3 million per hospital. Additional analyses evaluated revenue and expenditure differences by hospital performance and patient characteristics.

Conclusions: Revenue and expenses for CABG hospitals in California vary greatly. A CEA using a linked clinical and financial dataset allows California hospitals to identify which financial resources to use and allocate effectively, redefine missions and objectives, improve financial standing, and design smarter growth strategies for hospital expenditures.